Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Circ Arrhythm Electrophysiol. 2013 Aug;6(4):675-81. doi: 10.1161/CIRCEP.113.000384. Epub 2013 May 31.
Esophageal perforations are a rare but devastating complication of atrial fibrillation catheter ablation. Rapid treatment is crucial to avoid permanent disabilities and death. Surgical treatment is considered the treatment of choice. Alternatively, single case reports describe successful esophageal stenting, but others discourage this approach because of fatal consequences.
We present 3 patients who developed esophagopericardial fistulas after radiofrequency catheter ablation of atrial fibrillation. Diagnosis and management with pericardial drainage and esophageal stenting, as well as long-term follow-up are described. Esophagopericardial fistulas occurred 26, 9, and 18 days after the ablation procedure. Symptoms leading to admission were recurrence of atrial fibrillation (n=1), elective control endoscopy for thermal lesion (n=1), and pain with swallowing (n=1). Computed tomography revealed esophagopericardial fistulas with pericardial effusion in all patients, while contrast leakage and air in the left atrium could be excluded. Broad-spectrum antibiotics were initialized, and minimally invasive pericardial drainage and esophageal stenting were performed. Stent dislocation occurred in 2 patients and was resolved by repositioning and clipping of the proximal stent end. After 45, 22, and 28 days, respectively, fistulas appeared closed and stents were removed. During follow-up, no embolic or septic events occurred. However, 2 patients underwent dilation of symptomatic esophageal stenosis in the formerly stented region.
An early minimally invasive approach consisting of pericardial drainage and esophageal stenting proved effective in treating patients with esophagopericardial fistulas. However, constant interdisciplinary communication and attention is needed to recognize and manage potential evolving complications promptly.
食管穿孔是心房颤动导管消融术罕见但严重的并发症。快速治疗至关重要，以避免永久性残疾和死亡。手术治疗被认为是首选治疗方法。然而，有单病例报告描述了食管支架置入术的成功，但也有其他报告不鼓励这种方法，因为会导致致命后果。
我们报告了 3 例在心房颤动射频导管消融后发生食管-心包瘘的患者。描述了诊断和心包引流及食管支架置入的治疗方法以及长期随访情况。食管-心包瘘分别在消融术后 26、9 和 18 天发生。导致住院的症状为心房颤动复发（n=1）、热损伤的选择性内镜检查（n=1）和吞咽疼痛（n=1）。所有患者的计算机断层扫描均显示食管-心包瘘并伴有心包积液，而排除了对比剂渗漏和左心房积气。初始应用广谱抗生素，并进行微创性心包引流和食管支架置入术。2 例患者发生支架移位，通过重新定位和近端支架端的夹闭解决。分别在 45、22 和 28 天后，瘘管闭合且支架被取出。在随访期间，没有发生栓塞或感染性事件。然而，2 例患者在前置支架区域出现症状性食管狭窄，行扩张治疗。
由心包引流和食管支架置入组成的早期微创方法在治疗食管-心包瘘患者方面是有效的。然而，需要进行持续的跨学科沟通和关注，以便及时识别和处理潜在的进展性并发症。
